What Was the Original Theory of Misophonia?

“Misophonia, which means ‘hatred of sound” was termed by Jastreboff and Jastreboff in 2001.”​

Source: HolgersFotografie/Pixaby used with permisson

After this cursory mention of the Jastreboff’s and their role in naming misophonia, academic authors often jump to their own interpretations about the disorder. This leaves readers wondering why these two esteemed doctors at Emory University thought to conceive of a new disorder in the first place.

In order to comprehend a newly proposed disorder, it is important to understand its history. If we don’t, members of the medical community often regard these disorders as "unreal" because descriptions of them have been haphazardly built out of ambiguous bits of information that ultimately don’t add up to anything grounded in theory. I like to call this process the “dominos of disbelief”. Misophonia is a very real condition that has unfortunately fallen victim to this phenomenon. In order to help put together the puzzle pieces of misophonia, let’s talk about the conception of the disorder, and the doctors who named it.

While working in their audiology clinic, the Jastreboff’s (who happened to be married) observed that some people reacted to sounds, such as chewing, pencil tapping, keyboard typing, and coughing, with high levels of irritability, sometimes to the extent of rage, or disorientation. This group of patients responded to “repetitive" and “pattern based noises.”

Unlike their patients with hyperacusis (a disorder in which individuals feel pain in response to loud sounds), individuals with misophonia appeared to respond to “repetitive” and pattern-based sounds with autonomic arousal. That is, upon presentation of such stimuli, patients reported rising stress levels (such as elevated heart beat, muscle tension and sweating) along with strong negative emotions. This was different from what the Jastreboffs had seen with regard to other forms of “decreased sound tolerance” such as tinnitus (ringing in one or both ears), hyperacusis, and phonophobia (fear of sound often secondary to hyperacusis).

Due to the high cost of research the Jastreboffs did not study their misophonia theory, but ventured to begin treatment at their clinic based on methods previously used for tinnitus and hyperacusis. Since then a small body of academic literature coupled with a great deal of popular press has emerged replete with consistent misunderstandings about the Jastreboff’s original concepts. Lets begin to set the record straight.

Although the Jastreboff’s suggested that misophonia involves negative associations between auditory, cognitive and emotional areas of the brain, they did not view misophonia as a “psychiatric disorder” and certainly not any specific one such as Obsessive Compulsive Disorder (personal communication, 2015). Similarly, the Jastreboff’s ideas about misophonia treatment were based on neuroplasticity (the brains ability to reorganize itself based on making new associations). This treatment has its roots in their tinnitus and hyperacusis retraining therapy. It is not simply “exposure therapy” as it is often described. Unfortunately, both research and treatment has followed some of these misconceptions.

Taking this step back, how should we conceptualize misophonia? I think a judicious way to describe the disorder is as one in which auditory stimuli provokes a neurophysiological response with accompanying negative, emotions, cognitions and behavior. Misophonia should not be referred to as a psychiatric disorder.

How should therapists treat misophonia? Therapists and doctors must be very clear that treatments are all experimental at this point and that efficacy studies will hopefully ensue. Therapists can also help sufferers cope by consulting and communicating with other clinicians across disciplines, and taking the initiative to utilize individualized strategies for each client.

Most of all, therapists and doctors can help by taking the time to learn about this easily misunderstand disorder, and sharing this knowledge with misophonia sufferers. As a psychologist who has misophonia (and who has raised a child with the disorder) I know this: In the case of misophonia knowledge may not be “power” but it can help take some of the “power” out of the disorder.

Often when we label we become the label, we grow the perception and it becomes an untenable energy that typically results in increased symptomatology. I had misophonia for most of my life. I say had because I no longer experience sound in a disordered way. In my case it was clearly the result of an overloaded nervousness sustem that was constantly on alert. By "taming" my autonomic nervous system and by training out a discordant brain wave pattern in my left temporal lobe I live and sleep in a world of peace. There are answers for those who choose to perceive their world differently. Thanks for this article.....

Thank you for your encouraging response. Personally, I am not a lover of labels either. However, there are two sides to that coin. Often people feel better when they know that their symptoms have a name. As far as I know the brain mechanisms underlying misophonia have only been hypothesized and are just beginning to identified through scanning, etc. in peer reviewed large sample studies. However, if there is something you can share that we don't know about please feel free to contact one of the researchers affiliated with IMRN. We are certainly open to any ideas that may help people. Dr. Hamilton, I am very glad that you live and sleep in peace and I hope the rest of us will join you soon. Thank you for writing.

In 1997 I completed Dr. Powell Jastreboff’s 2nd Tinnitus Retraining Course. I opened my clinic right away and started seeing patients with unusual symptoms. After 3 or 4 identical cases, I realized the symptoms were so similar, this was not related to Tinnitus or Hyperacusis. By 1999; I had gathered over 500 similar patients and cases in a Yahoo Support Group. I named it Selective Sound Sensitivity Syndrome. Or 4S. I coined the word triggers. I consulted with Dr. J often and we exchanged ideas on using sound generators and educational counseling. In 2002, he chose the name Misophonia. I discovered that nearly half of these individuals have visual triggers as well as auditory ones. The vast majority have sudden onset in childhood, between ages 8-13. Pre puberty changes are probably related to onset. I formed a network of 12 Audiologists across the USA who could help these cases and diagnose under the code Abnormal Auditory Perception. In 2011 the NYT wrote an article about the subject and featured me. I went on the Today Show and Good Morning America. The first Patient Convention was held in Portland, Oregon in 2013, and the Misophonia Association formed. We are preparing for the 5th Patient Convention in 2018. There are many helpful resources to be found on our website along with video downloads of all of the Convention presenters.